piperidines and Vocal-Cord-Paralysis

The evolution of novel techniques for the treatment of laryngeal pathology has led to a significant expansion of the role of diagnostic assessment and the range of laryngeal procedures performed. These procedures typically benefit from an anesthetic approach that diverges from a standard general endotracheal or laryngeal mask airway-based inhalational anesthetic. The shared airway, need for intraoperative assessment of vocal cord function, risk of airway fire, and desire for rapid emergence and discharge are all important factors. In this article the authors undertake a collaborative anesthesia-surgical discussion of anesthetic management for airway procedures that are optimally performed with a spontaneously breathing, cooperative patient. An overview of pharmacologic approaches to airway anesthesia and cooperative sedation, followed by a discussion on the surgical requirements and anesthetic goals of commonly performed procedures, are presented.

Topics: Analgesics, Opioid; Anesthesia, Local; Anesthetics, Intravenous; Anesthetics, Local; Cough; Female; Humans; Lidocaine; Middle Aged; Otorhinolaryngologic Surgical Procedures; Patients; Piperidines; Remifentanil; Respiratory Physiological Phenomena; Vocal Cord Paralysis; Wakefulness

Medialization thyroplasty is a surgical technique for improving voice quality, cough effort and laryngeal competence in patients with unilateral vocal fold paralysis. Precision surgery is enabled by operating under total intravenous anaesthesia with controlled ventilation and by using a laryngoscopic video-assisted technique. The anaesthetic challenge is to manage the shared airway with the surgeon, provide a stable operative field and ensure patient safety throughout the procedure. The objective of this case series was to evaluate the use of a modified general anaesthetic technique using the laryngeal mask airway, total intravenous anaesthesia with controlled ventilation.. In all, 29 patients underwent medialization thyroplasty using a disposable laryngeal mask airway, total intravenous anaesthesia and controlled ventilation. Standard anaesthetic monitoring including capnography was used intraoperatively. Total intravenous anaesthesia was achieved using effect site target-controlled infusions of propofol and remifentanil.. The technique proved safe with stable haemodynamic observations and only two minor complications. It also provided the surgeon with stable view of the vocal folds in order to perform this precision surgery under an operating microscope.

Topics: Adolescent; Adult; Aged; Anesthesia, General; Anesthetics, Intravenous; Capnography; Child; Female; Hemodynamics; Humans; Intraoperative Complications; Laryngeal Masks; Laryngoscopy; Male; Microscopy; Middle Aged; Monitoring, Intraoperative; Piperidines; Positive-Pressure Respiration; Propofol; Remifentanil; Video-Assisted Surgery; Vocal Cord Paralysis; Voice Quality